COVID-19 Update from Dr. Smith: 5/02/20

Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.

Dear Colleagues,

I just returned from a seemingly urgent, abuse-of-privilege visit to my dentist.  The headline:  I will survive.  Her reassurance was very effective.  My attempts to return the favor by riffing on the broken curve were less so.  Her practice illustrates some of our most vexing reopening challenges.  Hers is a high-turnover practice, with a very small waiting room in a building with no lobby and no obvious place to sequester waiting patients.  The source of her PPE is not NYP or Columbia.  She is her source, like me sourcing paper towels in town.  She has staff to pay on reduced income.  Her local school is closed for the year, stranding all working parents without childcare.  But it’s worse than that.  Dentistry, oral surgery, and ENT have unique and serious exposure hazards.  Most of their procedures are aerosolizing.  Invading the oropharynx is Pickett’s charge in our war with coronavirus.  Familiar outer office protections like spacing, simple masks, and handwashing protect patients and staff alike, but in the procedure rooms the pendulum swings towards the need to protect doctors and staff from patients.  N95s and face shields are essential equipment, not talismans to superstition.

With few exceptions the Department’s restart planning deals with risk more evenly apportioned between seats and stage.  There is great variety in floor plans across all of our sites but in general we will be able to achieve reasonable social-distancing, perhaps by relying on staggered scheduling.  Procedures aside, PPE use should be relatively straightforward, and typical office interactions won’t strain N95 supplies because they will seldom be necessary.  This brings me to recently released guidelines advising us to protect reception desks with plexiglass.  To me, this is not how we project our confidence in the COVID security of our offices.  I base this opinion on my assumption that coronavirus is already so widespread in our region that patients in our waiting rooms have as much to fear from each other as from us, and we have as much to fear from each other as from them.  How much will a plexiglass barrier reduce risk of transmission?  Even without 6-foot markers on the floor it’s likely both parties will be separated by a few feet, the receptionist will be masked, the patients will be masked, and neither will be aerosolizing.  The next steps after the reception area are evaluation and treatment, which are much more intimate, and won’t be done across a plexiglass barrier.  What does a plexiglass shield say about who fears whom?  Patients approaching our receptionist have already decided that being seen was worth whatever risks might be associated with the visit.  The barrier spotlights the risk the patient poses to our staff and personalizes it—"I will talk to you now through glass, Mr. Fomite.”  We are not a pawn shop, and we shouldn’t give that impression.

Omnivorous readers with sharp eyes will have noticed that the more prestigious print media have suddenly transformed COVID to Covid, or even covid.  This holds true whether or not the writer is showing off covid’s fancy prime number (19).  The applicable convention appears to be that acronyms of 5 letters or less can be written in caps or lower case.  Transition to lower case tends to occur when the acronym becomes so commonplace that it’s comfortable dressing like a noun-at-birth (radar).  Lower case is not allowed when confusing homonyms result (AIDS versus aids).  Why now, I wondered.  Was there a secret meeting between the heads of the media families?  Does this signal solidarity with our President’s undermining of WHO, whence COVID-19 cometh?  If caps are a form of shouting, maybe covid is losing its voice.  In the sense that lower case is lower, it’s an insulting demotion for the disease caused by SARS-CoV-2.  We’ll demote that next.

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC

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